Noninvasive reconstruction of cardiac electrical activity: update on current methods, applications and challenges

Abstract

Electrical activity at the level of the heart muscle can be noninvasively reconstructed from body-surface electrocardiograms (ECGs) and patient-specific torso-heart geometry. This modality, coined electrocardiographic imaging, could fill the gap between the noninvasive (low-resolution) 12-lead ECG and invasive (high-resolution) electrophysiology studies. Much progress has been made to establish electrocardiographic imaging, and clinical studies appear with increasing frequency. However, many assumptions and model choices are involved in its execution, and only limited validation has been performed. In this article, we will discuss the technical details, clinical applications and current limitations of commonly used methods in electrocardiographic imaging. It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results. This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.

Influence of Torso Model Complexity on the Noninvasive Localization of Ectopic Ventricular Activity

“…The number of the electrodes used for BSPMs varies up to 256 [13]. The amount and positions of BSPM leads required for accurate inverse solution was studied by van der Graaf, Lux and Hoekema in [14], [15], [16].…”

“…It was shown elsewhere that for accurate inverse solution patient-specific geometry should be used [13], [17], [18]. Precision of the reconstruction of the patient-specific geometry from CT images was studied by Prakosa in [19] and its influence on accurate electrophysiological imaging by Rahimi [20].…”

Life-long tailoring of diagnosis and management of patients with idiopathic ventricular fibrillation—future perspectives in research

“…Electrocardiographic imaging (ECGI) is an emerging high-resolution non-invasive imaging modality for mapping the electrical activity in the heart [17, 18]. ECGI employs mathematical formulations to reconstruct the electrical activity at the level of the heart muscle, from extensive body-surface electrocardiograms and a digital, patient-specific body and heart geometry.…”

New approaches to predicting the risk of sudden death

“…It has been proposed that ECG imaging could be used to identify repolarisation abnormalities, fractionated signals and lowamplitude electrograms that are potential substrates for malignant arrhythmias. 50 This could be applicable to those with cardiomyopathy, post-MI or inherited cardiac conditions. There may also be a role in supporting ventricular tachycardia ablation.…”